FASTAFF REQUIRED DOCUMENTATION CHECKLIST

Thank you for your interest in Fastaff. We are excited about the opportunity to work with you! This document provides you a list of documents required by Fastaff that must be submitted before your first day on the job. We list the documents needed and a link to additional information regarding that document. You can keep track of what you have submitted to Fastaff here as well.

Minimum Documents Required Prior to Submitting Your Profile to Hospital

Document Name Description Submitted to Fastaff

Application Can be completed at http://www.fastaff.com/apply. Enter your Email to start the Application Process.

Skills Checklists All Registered Nurses will complete a minimum of two skills checklists:

1) Essential/Practical Skills2) Specialty Checklist(s); specific to unit in which you will be

workingCertifications Front and back copies of all required resuscitation credentials.

RN License Please provide copy of all active and inactive state licenses. (Fastaff may be able to help you reactivate your expired or inactive licenses)

References/Evaluations Two Evaluations from a Supervisor; must be in a support of positions worked within the last two years. Download References/Evaluations forms here.

Additional Documents Required Before Travel

Document Name Description Submitted to Fastaff

I-9 Form Fastaff needs a signed, notarized original copy mailed to our corporate office. Download I-9 Form Here

2 forms of Identification

Current Driver’s license, Social Security Card, Passport are acceptable. Please scan and submit clear copies.

Additional Documents Required Before Travel – Cont.

Document Name Description Submitted to Fastaff

Orientation Modules Online modules sent to your email prior to your first assignment.

Acknowledgment Documents

Employment Handbook, Drug and Alcohol Policy, HIPAA Confidentiality and Consumer Authorization documents sent to your email for electronic signature.

Competency Exam(s) Online Unit Specific Competency Test(s) sent to your email prior to your first assignment.

TB, Chest X-Ray and TB Questionnaire

Negative TB screen within one year; or, if history of positive results, a Chest X-ray (dated after positive TB) as well as annual TB questionnaire is required. Chest X-ray is one time requirement unless otherwise designated by individual facility.

Physical Annual Physical. Download a Physical form here.

Rubeola / Rubeola Positive titers or proof of MMR vaccine or history of disease if born before 1957.

Varicella Positive titer or proof of Varicella vaccine.

Hepatitis B Positive titer or proof of series of 3 vaccines or signed declination document.

Tetanus Proof of tetanus shot within 10 years or signed declination document.

Additional Documentation Needed Once You Accept an Assignment

Document Name Location/Description Submitted to Fastaff

Federal W-4 Completed W-4 is needed. Download a Federal W-4 form here.

FASTAFF Direct Deposit Provide necessary information for Direct Deposit. Download a Direct Deposit form here.

If you have any questions please do not hesitate to contact your recruiter. FASTAFF, Inc. | 1-800-736-8773 | Fax: 888-508-7854 | www.Fastaff.com

I-9 COMPLETION INSTRUCTIONS

If you have received an offer and are going to accept an assignment with Fastaff Travel Nursing or US Nursing, you must complete a Department of Homeland Security Form I-9, Employment Eligibility Verification for our file.

Following is a 2-page letter which should be given to the Notary Public who will be acting as an Authorized Representative for FASTAFF and an instruction sheet printed by the DHS. These contain an explanation for Section 1 to be completed by the employee, and for Section 2 to be completed by the Notary Public.

Print the instruction sheets, the I-9 form, the List of Acceptable Documents and the Notary Public I-9 Information Verification Certificate. Take this to a Notary and in front of the notary complete Section 1, sign it, date it, and DON’T FORGET to check the appropriate box indicating your citizenship status. The Notary should then complete either Section 2 of the I-9 Form, or the Notary Public I-9 Information Verification Certificate. Both do not need to be completed by the Notary.

Present the Notary with your original document(s) (copies are not acceptable) indicating your eligibility to work in the US. The Notary should enter the appropriate document info on the appropriate lines: i.e. if you are using a passport, this is a document from List A (no additional documents are needed). Document title should be “USA Passport”, Issuing Authority should be whichever governmental department or agency issued the passport such as New Orleans Passport Agency, or Department of State. This information is generally found near the bottom right of the passport. The document number will be the passport 9-digit number in the upper right portion of the passport, and the expiration date needs to be listed as well. If you are not using a passport or another document from List A, you must have a document from List B AND a document from List C. Refer to the Lists of Acceptable Documents which follows the I-9 form.

If the Notary does not want to enter the document information on the I-9 form, the I-9 Information Verification Certificate can be used, as long as there is document information from a List A document entered on the first line OR document information from a List B document on the first line and from a List C document on the second line.

Immediately upon completion send the Original I-9 form with copies of the documents used for verification to our office. The address is at the bottom of the Notary Public memo.

TO: NOTARY PUBLIC

RE: I-9 FORM COMPLETION AND SUPPORTING DOCUMENTATION

FASTAFF is an organization that provides health care workers to client facilities throughout the United States. Our business requires the company to hire remote workers. The Immigration Reform and Control Act (IRCA) requires all U.S. employers to verify the employment eligibility and identity of all employees hired to work in the United States after November 6, 1986. To implement the law, employers are required to complete Employment Eligibility Verification forms (Form I-9) for all employees, including U.S. citizens. A blank copy of the I-9 form is enclosed with this letter.

NOTARY AS EMPLOYER’S AGENT. The person presenting the I-9 form to you is a prospective employee for our company. Because it is not physically possible for this person to come to our offices in Denver, Colorado to complete the I9 paperwork, the United States Customs and Immigration Service (USCIS) allows employers to designate agents, such as you, to carry out their I-9 responsibilities. The law does not allow the employer to carry out I-9 responsibilities by means of documents faxed by an employee.

EMPLOYEE MUST COMPLETE SECTION 1 OF FORM. Our employee must complete Section 1 of the Form I-9. The employee’s signature holds him/her responsible for the accuracy of the information provided. No documentation is required to substantiate Section 1 information provided by the employee.

NOTARY MUST COMPLETE SECTION 2 OF FORM. The employer, or the designated agent, must review original documents and complete Section 2 of the Form I-9. We are asking you to act as our agent and review the documents for us to satisfy this requirement.

FASTAFF is responsible to ensure proper completion of the entire form. Proper documentation establishes both that the employee is authorized to work in the U.S. and that the employee who presents the employment authorization document is the person to whom it was issued.

The official list of acceptable documents for establishing identity and work eligibility is enclosed with this letter being presented by our prospective employee.

1. You may accept any List A document, which establishes both identity and workeligibility.

FASTAFF has earned the Joint Commission’s Gold Seal of Approval

2. OR, you may accept one document from List B (establishing identity) and onedocument from List C (establishing work eligibility).

You should examine the document(s) and accept them if they reasonably appear to be genuine and if they reasonably appear to relate to the person standing before you. Requesting more or different documentation than the minimum necessary to meet this requirement may constitute an unfair immigration-related employment practice. If the documentation presented by an employee does not reasonably appear to be genuine or relate to the employee who presents them, then you must refuse to accept them, and you must ask for other documentation from the list of acceptable documents.

GENUINENESS OF DOCUMENTS. You are not required to be a document expert. In reviewing the genuineness of the documents presented by an employee, employers are held to reasonableness standards.

PHOTOCOPIES OF DOCUMENTS NOT ACCEPTABLE. You cannot accept photocopies of identity or employment eligibility documents to fulfill I-9 requirements. Only the original documents, meaning the actual document issued by the issuing authority, are satisfactory with the single exception of a certified photocopy of a birth certificate. Please make copies of the documents presented by the employee to be sent with the completed I-9 form, as we would like to retain photocopies with the completed I-9 form.

ENCLOSURES. Thank you for accepting this commission. Enclosed please find the original Form I-9, the list of acceptable documentation, and Instructions for Completion of the form.

Sincerely,

FASTAFF Travel Nursing Records Department 6501 South Fiddlers Green Circle, Suite 200 Greenwood Village, Colorado 80111

NOTARY PUBLIC I-9 Information Verification Certificate

On , in the State of (date)

County of ______________________, Name of employee/traveling RN

Personally submitted to me, Name of Notary Public

I attest, under the penalty of perjury, that I have examined the documents(s) listed. (See “Lists of Acceptable Documents” located on reverse of Department of Homeland Security – Employment Eligibility Verification Form I-9).

Document Title /Issuing Authority /Document # /Exp.Date if any

AND/OR

Document Title /Issuing Authority /Document # /Exp.Date if any

These documents were presented by the above-named person and appear to be genuine and relate to this person.

Witness my hand and seal.

Notary Public Signature Date

This form must accompany the I-9 with the upper portion filled in by the applicant and signed.